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Objective:To analyse clinical outcomes and risk factors of vascular crisis on patients received oral and maxillofacial defect repairations with free tissue flap.Methods:From January, 2013 to July, 2018, 1 049 patients with soft tissue defect of oral and maxillofacial were reconstructed with free tissue flap, in which 64 cases occurred vascular crisis. Among the cases, 28 defect were reconstructed with radial forearm free flap (RFFF), 19 with anterolateral thigh flap (ALTF), and 17 with fibula flap. All patients underwent surgical exploration. The clinical data and surgical outcomes were collected. The univariate analysis and multivariate regression analysis were performed by using SPSS version 22.0 software. The result was supposed to statistically significant when P<0.05. Results:Among 64 patients occurred vascular crisis, 44 flaps were rescued successfully by surgical procedures (68.8%). Univariate analysis revealed that the salvage rate was related to the smoking history, type of tissue flap, time of vascular crisis occurrence, cause of vascular crisis and the time interval between crisis occurrence and surgical exploration ( P<0.05). Multivariate regression analysis revealed that only type of tissue flap, the time of vascular crisis occurrence and the interval time were the independent significant factors for salvage rate ( P<0.05). Conclusion:The salvage rate became higher when the vascular crisis occurred earlier, and the interval time was shorter. The type of tissue flap could affect the outcome of surgical exploration. The success rate decreased with an order of RFFF, ALTF to fibula flaps. The primary principle in the management of vascular crisis was early identification and early surgical exploration.
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Objective To investigate the effect of the different rehabilitation training method on the first ray of postoperative hallux valgus (HV). Methods Based on medical images of HV patient, a comprehensive three-dimensional finite element model of HV foot was established, including bones, sesamoid, cartilage, ligaments, soft tissues, Achilles tendon. The passive/active plantar flexion and dorsal flexion as well as standing were simulated to investigate the biomechanical behavior of distal osteotomy fragment of the postoperative HV. Results The stress distribution on distal osteotomy fragment during passive training was more uniform, and the peak stress (7.78 MPa) was greater than that during stance phase and active training. The distal osteotomy fragment displacement during passive training (0.98 mm) in anterior-posterior direction was greater than that during stance phase (0.69 mm) and active training (0.38 mm). Conclusions The passive training could promote the contact of osteotomy surface and reduce the healing time of osteotomy, which would be beneficial for rehabilitation of postoperative HV.
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Objective@#To explore the value of different designed anterolateral thigh flaps(ALT) in the reconstruction of buccal defect after radical resection of buccal cancer.@*Methods@#From March 2009 to May 2016, 142 cases were diagnosed as buccal cancer in the Department of Oral and Maxillofacial Surgery of Nanjing University. All patient underwent radical resection, followed by reconstruction with different anterolateral thigh flaps. The clinical date were retrospectively analyzed.@*Results@#Among 142 cases, the muscuiocutaneous ALT flaps were used in 60 cases, the fasciocutaneous ALT flaps in 60, and the thin ALT flaps in 22. The size of the flaps ranged from 4 cm×5 cm to 14 cm×10 cm. Operative exploration during the perioperative period were performed in 4 patients, including 2 flaps with thrombotic events and 2 flaps with venous thrombosis. Among them, 2 flaps survived completely and 2 flaps were failure. The mean follow-up period was 37 months(range: 3 to 85 months).@*Conclusions@#The different designed anterolateral thigh flap for the buccal defects resulting from tumour excision is an ideal choice for reconstruction of buccal defects.
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BACKGROUND:There is a lack of study on material properties and parameters of foot finite element models in China. Vernier caliper is a common method for measuring the width and thickness of ligaments and tendons to calculate the cross-sectional area. OBJECTIVE:To design a new ligament cross-sectional area measuring instrument to improve the measurement accuracy. METHODS:The cross-sectional area of the five fresh cadaver ankle ligaments was respectively measured using the new instrument and vernier caliper, and then a comparative analysis of the two measurement methods was performend. RESULTS AND CONCLUSION:The cross-sectional area of anterior talofibular ligament, calcaneofibular ligament, tibionavicular ligament and calcaneotibial ligament was (20.61±7.52), (22.38±11. 49), (33.09±9.91) and (28.20±10.88) mm2, respectively measured by the vernier caliper, and (17.59±4.03), (20.77±7.91), (28.08±8.14) and (30.39±7.98) mm2 by the new ligament cross-sectional area measuring instrument. These results suggest that this new measuring instrument is accurate, reliable and easy to operate, which can be used as a special instrument to measure ligament cross-sectional area, but further studies wil be necessary.
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Objective To know the usage of Chinese patent medicine of western medicine doctors in general hospitals. Methods By means of informal discussion with experts, present situation was known; By means of screening questions in questionnaire, nationwide investigation was conducted by this questionnaire about Chinese patent medicine and the results were examined by statistical analysis. Results That the abuse of Chinese patent medicine by western medical doctors was quite common. The overall quality of their prescriptions was not good. Most of the doctors have never received specialized continuing education of traditional Chinese medicine, only having preliminary knowledge or nothing on syndrome differentiation and treatment of traditional Chinese medicine. Conclusion The management department should take following measures: further enhance continuing education of TCM;formulate related policies;improve present situation.
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BACKGROUND:Integrated Traditional Chinese and Western Medicine minimaly invasive treatment for halux valgus based on wrapped curtain method with “8”-shaped bandage and sub toe pad external fixation has been used for a long time in the clinic. This method abandons the internal implant fixationandexternal plaster fixation. After surgery, patients could take care of themselves. However, theactivity of the broken end may cause fracture nonunion, which once aroused scholars’ question. Recently, with the continuous improvement of foot biomechanics research, foot finite element model and applications become a reality. OBJECTIVE:To evaluate thestability of osteotomy after the operation of wrapped curtain method with“8”-shaped bandage and sub toe pad external fixation on the basis of static finite element method. METHODS:A young female volunteer with halux valgus was selected, whose body weight was 58 kg, and right foot halux abductor valgus angle was 24°; intermetatarsal angle was 13°; proximal articulator set angle was 7°; distal articulator set angle was 7°. CT was used to scan the right foot. ABAQUS software was applied to establish a finite element model of right foot halux valgus bone, and model of the first metatarsal neck minimaly invasive osteotomy was simulated based on wrapped curtain method with external fixation. Von Mises stress and displacement at the osteotomy endwere calculated. RESULTS AND CONCLUSION:(1) The maximum stress was 0.067 MPa without external fixation, and the maximum stress was 1.258 MPa with the external fixation. Stress was mainly distributed in the outer edge of the osteotomy. (2) The maximum absolute displacement was 0.363 mm without external fixation, and the maximum absolute displacement was 0.716 mm with external fixation. The two largest displacements were both in the Z-axis direction. Statistical analysis confirmed that the four nodes absolute displacement and stress were significantly different (P 0.05). The four nodes relative displacements were statisticaly significant in Z-axis (P< 0.05). (5) These findings suggest that the external fixation based on wrapped curtain method after halux valgus surgery could effectively reduce osteotomy displacement. The moderate stress and elastic fixation are conducive to fracture healing.
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al from abroad, which have no reports in China. METHODS: The dissection of flexor policis longus tendon and flexor policis brevis muscle and the medial and extensor halucis longus, flexor policis longus, adductor muscle and abductor halucis muscle cross head and oblique head, medial and lateral head of flexor policis brevis muscle and flexor halucis longus tendon and the extensor halucis longus tendon. These parameters included length, width, thickness, cross-sectional area, lateral heads, extensor halucis longus muscle and tendon and the transverse head of adductor policis muscle and the oblique head, abductor policis brevis from the left leg and foot of fresh female specimens was performed. The cross-sectional area and length located in a fixture were measured and calculated for each sample. Sample loading was done, and one sample was measured four times to gather strength limit, maximum load data, and the load displacement curve. According to Hooke’s law, the elastic modulus of each specimen was calculated. al from abroad, which have no reports in China. METHODS: The dissection of flexor policis longus tendon and flexor policis brevis muscle and the medial and extensor halucis longus, flexor policis longus, adductor muscle and abductor halucis muscle cross head and oblique head, medial and lateral head of flexor policis brevis muscle and flexor halucis longus tendon and the extensor halucis longus tendon. These parameters included length, width, thickness, cross-sectional area, lateral heads, extensor halucis longus muscle and tendon and the transverse head of adductor policis muscle and the oblique head, abductor policis brevis from the left leg and foot of fresh female specimens was performed. The cross-sectional area and length located in a fixture were measured and calculated for each sample. Sample loading was done, and one sample was measured four times to gather strength limit, maximum load data, and the load displacement curve. According to Hooke’s law, the elastic modulus of each specimen was calculated. Abstract BACKGROUND:Currently, the material parameters of foot three-dimensional finite element models are almost OBJECTIVE:To preliminarily measure the parameters of foot muscle and tendon materials in Chinese people. RESULTS AND CONCLUSION: Relevant measurement data were harvested from nine samples, including the maximum loading, ultimate strength and elastic modulus test.
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Objective To evaluate the application of three-dimensional measurement and computer-aided navigation system in treatment of orbitozygomatic complex fiacture.Methods Pre-and post-operative three-dimensional measurements were taken by Mimics software to locate the zygomatic bones of 15 patients with orbitozygomatic complex ftacture to determine distance of optical foramen to zygomaticotemporal suture (On-Zm)/ zygomaticofrontal suture (On-Or)/zygomaticomaxillary suture (OnTz),horizontal angle of zygomatic arch,horizontal angle of the zygomatic process,and inferior angel of the frontal process of zygomatic bone.Preoperative design and simulation,intraoperative real time navigation and postoperative evaluation were applied using computer assisted navigation system.Results OnTz,On-Or,and On-Zm was (48.6-±4.5)mm,(42.5±2.2)mm,and (47.5±3.2)mmin the unaffected side,but was (50.4 ± 2.2) mm,(37.2 ± 1.0) mm,and (53.4 ± 3.6) mm in the affected side before operation (P ＜ 0.05).Whereas On-Tz,On-Or,and On-Zm improved to (46.4 ± 3.7) mm,(41.2 ± 1.8) mm,and (46.4 ± 2.5) mm in the affected side after operation,similar with the values in the unaffected side (P ＜ 0.05).Horizontal angle of zygomatic arch,horizontal angle of the zygomatic process,and inferior angel of the frontal process of zygomatic bone was (144.7 ±4.1)°,(132.5 ± 2.3)°,and (112.0 ± 3.4)° in the affected side,with significant differences from (150.3 ± 8.0)°,(141.1 ±4.2)°,and (114.9 ±5.1)° in the affected side before operation (P ＜0.05),but they were improved to almost the normal values (144.6 ± 4.1) o,(132.8 ± 2.0) °,and (111.9 ± 3.6) ° after operation.Satisfactory surgical outcomes,such as three dimensional symmetry and recovery of normal mouth-openingand occlusion,had been achieved.Conclusions Three-dimensional measurement is a quantitative study on the spatial displacement of orbitozygomatic complex.Combined with computer-assisted navigation system with preoperative design and simulation,intraoperative real time navigation and postoperative evaluation,three-dimensional measurement attains the overall management of orbitozygomatic complex fracture.
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Objective To investigate the cause of metastatic metatarsalgia after hallux valgus surgery and the clinical outcomes of Weil osteotomy for metastatic metatarsalgia after hallux valgus surgery. Methods From July 2009 to Janurary 2012, data of 27 patients (27 feet) with metastatic metatarsalgia of 2nd to 4th head of metatarsal bone after hallux valgus surgery who had been treated by Weil osteotomy were retrospectively analyzed. There were 1 male and 26 females with an average age of 51 years (range, 28-73 years). Metatarsalgia occurred 6-24 months after operation for hallux valgus. 13 feet underwent mini-invasive cervi-cal wedge osteotomy of the first metatarsal, 7 with Chevron procedure, 5 with Akin procedure, and 2 with Lapidus procedure. No shortening in first metatarsal was found in 5 feet with Akin osteotomy, while there were varying degrees of shortening in first meta-tarsal in the remaining 22 feet. The clinical results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores. The preoperative and postoperative plantar pressure changes were tested by plantar pressure tester. Results 25 Patients were followed up for 12-42 months (average, 24 months). Among these 25 cases, the metatarsalgia of 23 cases were completely disappeared. The metatarsal plantar lateral metastatic pain occurred in the remaining 2 cases (2 feet) and 1 was relieved by the foot pad, 1 was cured by re-Weil osteotomy. AOFAS score was 46.82 ± 6.13 before surgery and 90.63 ± 1.65 after surgery. The VAS score was 7.5 (6, 7) before surgery and 0.5 (0, 1.0) after surgery. The last follow-up, according to the score of AOFAS toe metatarsophalangeal-interphalangeal joint, of which 23 cases were excellent, 1 good, 1 poor;the excellent and good rate was 96%(24/25). Preoperative pressure under 2nd to 5th metatarsal head were 3.12±1.62 Pa, 5.81±1.92 Pa, 4.63± 2.10 Pa, 3.37±1.57 Pa, 1.67±1.20 Pa and postoperative were 3.33±1.35 Pa, 3.89±1.08 Pa, 3.65±1.96 Pa, 2.25±1.23, (1.48±1.11) Pa. Postoperative pressure under 2nd to 5th metatarsal head were significantly decreased. Conclusion Weil osteotomy can effec-tively adjust the length of the metatarsal and the height of metatarsal head, thus effectively improve the pressure under the metatar-sal head, so it could reach a good effect in the treatment of metastatic metatarsalgia after hallux valgus surgery.
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BACKGROUND:At present, there are many clinical trials concerning plate fixation and smal splint for distal radius fracture, but there is lack of systemic evaluation. OBJECTIVE:To evaluate the curative effect of the plate fixation and smal splint in the treatment of intraarticular fractures of the distal radius. METHODS:We retrieved the Chinese biomedical database (1979-2008), China National Knowledge Infrastructure (1979-2008), VIP database (1989-2008) and Wanfang Digital Periodical Group (1998-2008). Of them, China National Knowledge Infrastructure contained Chinese periodical databases, important meeting ful-text databases, and Master-Doctor thesis database. Foreign databases included PubMed (1966-2008), EMbase (1980-2008) and the Cochrane Library (2008, 4th). The ful text that could access was supplemented by manual search back issues of Traditional Chinese Medicine, Tianjin University Library repository. Clinical randomized control ed trials addressing plate fixation with smal splint in the treatment of intraarticular distal radius fractures were col ected. The data were extracted independent by two evaluators and methodological quality assessment was performed. According to the search strategy and data col ection methods, 363 English articles and 488 Chinese articles were found, including 401 periodical literatures, 79 conference proceedings, and 8 theses. After reading title, abstract, ful text, 12 articles met the inclusion criteria. Meta analysis was conducted with RevMan 5.0.20 software provided by the Cochrane Col aboration Network. RESULTS AND CONCLUSION:The evaluation of this system involves locking compression plate, normal internal fixation with plate, smal splints and plaster external fixation methods. Meta analysis of the results shows that the curative effects of locking compression plate in the treatment of intraarticular fracture of distal radius were better than that of common plate, smal splint or gypsum. Moreover, there were few complications. There is no significant difference in the effects between common plate fixation in treatment of intraarticular fracture of distal radius and the fixation with smal splint or gypsum.
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Objective To evaluate the long-term results of minimal incision osteotomy for hallux valgus.Methods From February 1996 to May 1999,372 cases(705 feet)with hallux valgus were treated with minimal incision osteotomy.Seventy-nine cases after surgery were followed up for more than 5 years,including 6 males(10 feet)and 73 females(140 feet)with an average age of 47 years(range,13-75 years).The average follow-up time was 7.5 years(range,5.3-13.2 years).The preoperative and postoperative hallux valgus angles(HVA),intermetatarsal angles(IMA),the tibial sesamoid position(TSP),American orthopedic foot and ankle society(AOFAS)score,range of movement of the first metatarsophalangeal joint,and lateral metatarsalgia etc.were observed and measured.And the clinic outcome were studied and evaluated.Results Based on Wen Jian-min's clinic curative effect evaluation criterion(2001),56 feet(37.3%)were excellent,88 feet(58.7%)good ,6 feet(4.0%)fair.The rate of excellent or good was 96.0%(144/150).The postoperative mean AOFAS score was 84.20±4.32 points(range,60-100 points).The mean HVA decreased from 33.28 to 12.31 degrees,the mean IMA from 11.75 to 6.80 degrees.The TSP was corrected from an average preoperative grade of 4.29 to a grade of 3.07 at final follow-up.There are no nonunion or delayed union of osteotomy,avascular necrosis of the 1st metatarsal head,infection,hallux varus.Four feet(2.7%)had numbness in the medial of the big toe.The 1st metatarsophalangeal joint range of motion decreased from 70.20 to 69.53 degrees.There were 97 feet(64.7%)with the 2-5 metatarsalgia before operation,and 35 feet(23.3%)disappeared,54 feet(36.0%)improved,8 feet(5.3%)aggravated after operation.Conclusion Minimal incision osteotomy technique is sound and reliable method to treat hallux valgus.The osteotomy technique is simple,and could provide satisfactory long-term results with lower complication rate.
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<p><b>OBJECTIVE</b>To evaluate the efficacy and feasibility of the Chinese drugs for supplementing Qi and activating blood circulation in preventing DVT after big operations in orthopaedics and traumatology and observe the change of D-dimer before and after treatment.</p><p><b>METHOD</b>Seventy patients ranging in age from 39 to 94 years who were treated by big operations in orthopaedics and traumatology were divided into two groups randomly. Traditional Chinese medinine (TCM) group (group A) and western medicine group (group B). On the 2rd day after operation d-dimer was tested from both groups and the patients in group A were given one dose of TCM every day and the patients in group B were subcutaneously injected low-molecular-weight heparins calcium (LMWH). On the 8th after operation d-dimer was tested again from both groups. The parameters, such as the incidence of DVT and pulmonary thromboembolism, bleeding condition, were evaluated respectively.</p><p><b>RESULT</b>The D-dimer decreased in group A and had significant difference (P < 0.05), group B had no significant difference, there was also no significant difference between two groups. DVT was found in 1 patient in group B (1/35). Petechiae were found in 10 patients in group A (10/35) and in 26 patients in group A (26/35), which had significant difference (P < 0.05).</p><p><b>CONCLUSION</b>Both the Chinese drugs and anti-coagulation drug can prevent the incidence of DVT effectively, and Chinese herbs are feasible in the prevention of DVT.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anticoagulants , Blood Circulation , Drugs, Chinese Herbal , Heparin, Low-Molecular-Weight , Orthopedic Procedures , Orthopedics , Postoperative Complications , Drug Therapy , Qi , Traumatology , Venous Thrombosis , Drug TherapyABSTRACT
Objective To discuss the clinical effects of knee osteoarthritis treated with arthroscope and electro-acupuncture. Methods 57 patients (57 knee joints involved) , who were diagnosed by physical examinations and MRI as knee osteoarthritis, were treated by arthroscopy preoperatively and electro-acupuncture and rehabilitation training postoperatively. Results Among the total of 57 cases, 39 cases were recovery (68%), 17 cases were improved (30%), l case was ineffective (2%). The score of preoperative and postoperative HSS assessment was ( 50.3 ± 5.42 )and ( 59.2± 5.28 )respectively (P < 0.05 ). Conclusion The treatment of knee osteoarthritis with arthroscope and electro-acupuncture is effective.
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[Objective] To retrospectively analyze the treatment of tailor's bunion with minimal incision osteotomy,and to investigate the indications and effects of this procedure.[Method]Thirty-seven patients(69 feet)underwent the procedure from July 2002 to August 2007.The axial and lateral films of all feet with loading were taken before and after operation.AOFAS were recorded and analyzed preoperatively and postoperatively.[Result]The forth intermetatarsal angle was 14.36??7.32? before operation and 9.36??2.92?after operation.The unguis aduncus angle of digitus quintus pedis was 20.44??7.36? before operation and 4.36??1.35?after operation.The forth reforming intermetatarsal angle was 10.36??.2.81? before operation and 7.83??2.37?after operation.The exstrophy angle of the fifth metatarsal was 5.46??1.70? before operation and 2.13??0.38?after operation.The score of AOFAS was 45.7?5.6 before operation and 85.3?5.1 after operation.[Conclusion]The treatment of tailor's bunion with minimal incision osteotomy is easy to operate and its therapeutic effect is convincing.
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[Objective]To explore the dependability between heredity and hallux valgus.[Method]A total(1 491) cases of family heredity of hallux valgus patients were investigated,the ages of these patients,ages of onset,ages of aggravation,hallux valgus angles were analyzed statistically.[Result]Conclusive family medical history exists in 69.48% of the(1 491) hallux valgus patients.There was distinguished difference between the patients with family history and those without heredity background on visiting ages,ages of onset,ages of aggravation;but no any difference between these two groups of patients on hallux valgus angles.[Conclusion]Heredity factor is the main cause of hallux valgus.It can influence only the onset of hallux valgus,but not the severe degree of latter.The patients with family history are earlier than those without heredity background about visiting ages,ages of onset,ages of aggravation.
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[Objective]To evaluate the value of diffusion weighted imaging(DWI)in breast disease.[Methods]7 cases suspected by molybdenum target and clinic were detected by MRI.we calculated ADC through two different b,also make time-signal plot.Then we compared the diagnostic conclusion to the normal MRI conclusion acquired with histopathological demonstration.[Results]3 cases were malignant,2 cases were benign and 2 cases were normal.The diagnostic coincidence rate of DWI and normal MRI was 100%.[Conclusion]DWI is a rapid and feasible method in detecting breast lesions.ADC is an effective parameter in discriminating malignant and benign breast lesions.
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Objective To study the relation between the pressure in forefoot and the second metatarsalgia in hallux valgus deformity, finally to quantitatively analyze the pressure under the second metatarsal head which is a dangerous factor leading to second metatarsalgia. Methods Three groups volunteered for this study by a self-devised foot pressure measurement system: fifty-eight normal subjects (116 feet) without pain and deformity in foot, thirty-two patients (45 feet) with hallux valgus and pain only under the second metatarsal head, fifty-six patients (102 feet) with hallux valgus without symptoms of metatarsalgia. The percentage of pressure to weight was the criteria for data analysis. First the pressures under second metatarsal head among three groups were compared with each other. Secondly we used case-control study to identify whether it was high pressure that was likely to result in metatarsalgia. Finally we compared the pressure interval under second metatarsal head among three groups to define the pressure interval which might be a dangerous factor to second metatarsalgia. Results 1)The pressure beneath the second meatatarsal head in patients with metatarsalgia was the highest in the three groups (P